Medical images are an important component of the medical record generated during a patient's hospital stay or clinic visit. Unfortunately, these images represent a difficult to manage data source due to the tremendous size of the datasets involved. The Clinical Center, like most university and research hospitals, is grappling with the problem of how to consolidate medical images with the conventional alphanumeric data contained within its Medical information system, in order to more completely realize their goal of a comprehensive electronic medical record. Toward this end, DCRT and the Clinical Center are collaborating to develop a series of demonstration projects aimed at supporting image integration into the electronic medical record. Images which concern us range in size from diagnostic electrocardiograms (16 Kbytes max) through tomographic scans (256 Kbytes max) to sheet film images (4 Mbytes max).